The offsite biometric screening form is used for those who are unable to attend an onsite screening and/or choose to submit results obtained by a physician.

Completed form is due on or before November 30, 2021 by 11:59 pm PST. Date of test must be on or after October 1, 2020.

Before you submit your form, make sure you have:


To submit your form, complete the fields below. Click Choose File to load your document, then click Upload Files.

Personal Details
 Date Format: YYYY-MM-DD
Upload Files

You will receive a confirmation email from US Wellness when your form is received and reviewed. If you do not receive an email confirmation within two business days or if you have questions regarding your form, please call US Wellness at 866-926-6099 x900.